We thank Dr. Fioravanti and colleagues for running this analysis in the Mediterranean population and validating the key findings of LEGACY (Long-Term Effect of Goal Directed Weight Management on Atrial Fibrillation Cohort: A 5 Year Follow-Up Study) (1). This study demonstrated that in overweight and obese individuals with symptomatic atrial fibrillation (AF), progressive weight loss had a dose-dependent effect on long-term freedom from AF. With weight loss, we saw reduced burden of AF and improved maintenance of sinus rhythm (1). Cardiac risk factors are associated with structural and electrical remodeling leading to development and progression of AF (2). Epidemiological studies confirm that the risk is dynamic in nature.

Fioravanti and colleagues, in a large cohort of patients, looked at the dynamic impact of weight on AF recurrence. The authors found an increased risk of AF with BMI >25 kg/m2. This study confirms the already established relationship between increased BMI and risk of AF. Additionally, it also testifies to the distinct effect of change in BMI on AF recurrence. Weight loss during follow-up was associated with reduced risk of AF, and a weight gain by contrast increased this risk. In addition, there was a dose-response effect of weight loss on AF recurrence. These findings are consistent with LEGACY study data.

Recent epidemiological data confirm the emergence of obesity and AF as global epidemics, conferring an enormous management and economic burden. The identification of risk factors for AF has ushered a risk factor–based approach for management. Indeed, aggressive management of risk factors with weight loss and increased physical activity are crucial elements in the management of AF (3,4).

Footnotes

Please note: Dr. Pathak is supported by a post-graduate scholarship from the Lion’s Medical Research Foundation, an Australian post-graduate award, and a Leo J. Mahar Electrophysiology Scholarship from the University of Adelaide. Dr. Mahajan is supported by the Leo J. Mahar Lectureship from the University of Adelaide. Dr. Lau is supported by a Postdoctoral Fellowship from the National Health and Medical Research Council of Australia and the Robert J. Craig Lectureship from the University of Adelaide. Dr. Sanders is supported by practitioner fellowships from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia; has served on the advisory board of Biosense-Webster, Medtronic, and St. Jude Medical; has received lecture and/or consulting fees from Biosense-Webster, Medtronic, and St. Jude Medical; and has received research funding from Medtronic, St. Jude Medical, Boston Scientific, Biotronik, and Sorin.

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